DARTHROPLASTY – Practical Training – Wet Labs
11-12th November 2016 – Warsaw and Legionowo, Poland.
Legwet Veterinary Clinic, Centro de Cirurgia Veterinária de Loures and KK-Art held a practical training on 11-12th of November 2016, in Warsaw and Legionowo – Poland. It was attended by veterinary doctors from several countries.
You can see the slideshow presentation by Dr. Rafael Lourenço
Part 1
DARTHROPLASTY – Practical Training – Wet Labs - Part 2Rafael Lourenço
DARTHROPLASTY – Practical Training – Wet Labs
11-12th November 2016 – Warsaw and Legionowo, Poland.
Legwet Veterinary Clinic, Centro de Cirurgia Veterinária de Loures and KK-Art held a practical training on 11-12th of November 2016, in Warsaw and Legionowo – Poland. It was attended by veterinary doctors from several countries.
You can see the slideshow presentation by Dr. Rafael Lourenço
Part 2
Club foot, also known as talipes, is a deformity present at birth where the foot is turned inward at the ankle and points down. It occurs in about 1 in 1000 births and can involve the varus, valgus, calcaneus, or equinus positions. Treatment initially uses plaster or fiberglass casts to stretch the foot into proper position, with serial casting over months. Surgery may be needed if casting fails or the foot is rigid. Developmental dysplasia of the hip is a hip joint malformation present at birth or shortly after, allowing the femoral head to ride upward out of the socket. It affects more females and is diagnosed using tests like Ortolani or Barlow along with x-rays
03 Cartilage And Bone Connective TissueKevin Young
This document provides an overview of bones and bone structure. It discusses how bones support vital organs, provide muscle attachments, and allow for body movement. It covers different bone cell types like osteoblasts and osteoclasts, bone growth and development, bone fractures and healing, and age-related bone conditions like osteoporosis. A variety of bone structures, features, and development processes are examined, from long bone anatomy to skull development.
This study retrospectively reviewed 29 patients (32 feet) who underwent dorsal anatomic plantar plate repair (DAPPR) in conjunction with a Weil osteotomy to treat instability of the second metatarsophalangeal joint. Post-operatively, patients had significantly reduced pain based on VAS and improved function based on AOFAS scores. Complications included three cases each of painful stiffness and painful hardware, and one painful scar, but there were no cases of floating toes or recurrence of instability. The authors conclude that DAPPR enhances visualization and repair of plantar plates compared to plantar approaches, with favorable post-operative outcomes.
Legg-Calve-Perthes disease is a condition characterized by osteonecrosis of the femoral head typically seen in children between the ages of 4-8 years old. It results from disrupted blood supply to the femoral capital epiphysis, leading to bone death and deformity of the femoral head over time. Treatment involves relieving pain, protecting weight bearing, restoring range of motion, and minimizing femoral head deformity. Younger children with milder involvement are often treated conservatively with bracing and activity restriction while older children or those with more severe involvement may require surgical procedures like varus derotation osteotomy to improve containment of the femoral head within the acetabulum. The goals of treatment are to improve mobility
This document discusses Perthes disease, which results from loss of blood supply to the femoral head, typically affecting children ages 3-10 years old. It covers the stages of the disease from initial avascular necrosis to healing. Diagnosis involves examining radiographic changes over time as well as using imaging modalities like MRI, CT, bone scans and arthrography. Treatment aims to contain the femoral head within the acetabulum during healing to prevent deformity. Differential diagnoses and related conditions are also reviewed.
This document provides information about Achilles tendinopathy, including:
- It is a common overuse injury among athletes and the general public.
- It can be classified based on its location as insertional, non-insertional, or proximal tendinopathy.
- Risk factors include excessive loading, tight calf muscles, foot abnormalities, and medical issues.
- Diagnosis involves physical exams like the Arc sign and imaging like ultrasound or MRI.
- Treatment begins with rest, bracing, eccentric exercises, and other conservative methods, with surgery reserved for severe cases.
DARTHROPLASTY – Practical Training – Wet Labs - Part 2Rafael Lourenço
DARTHROPLASTY – Practical Training – Wet Labs
11-12th November 2016 – Warsaw and Legionowo, Poland.
Legwet Veterinary Clinic, Centro de Cirurgia Veterinária de Loures and KK-Art held a practical training on 11-12th of November 2016, in Warsaw and Legionowo – Poland. It was attended by veterinary doctors from several countries.
You can see the slideshow presentation by Dr. Rafael Lourenço
Part 2
Club foot, also known as talipes, is a deformity present at birth where the foot is turned inward at the ankle and points down. It occurs in about 1 in 1000 births and can involve the varus, valgus, calcaneus, or equinus positions. Treatment initially uses plaster or fiberglass casts to stretch the foot into proper position, with serial casting over months. Surgery may be needed if casting fails or the foot is rigid. Developmental dysplasia of the hip is a hip joint malformation present at birth or shortly after, allowing the femoral head to ride upward out of the socket. It affects more females and is diagnosed using tests like Ortolani or Barlow along with x-rays
03 Cartilage And Bone Connective TissueKevin Young
This document provides an overview of bones and bone structure. It discusses how bones support vital organs, provide muscle attachments, and allow for body movement. It covers different bone cell types like osteoblasts and osteoclasts, bone growth and development, bone fractures and healing, and age-related bone conditions like osteoporosis. A variety of bone structures, features, and development processes are examined, from long bone anatomy to skull development.
This study retrospectively reviewed 29 patients (32 feet) who underwent dorsal anatomic plantar plate repair (DAPPR) in conjunction with a Weil osteotomy to treat instability of the second metatarsophalangeal joint. Post-operatively, patients had significantly reduced pain based on VAS and improved function based on AOFAS scores. Complications included three cases each of painful stiffness and painful hardware, and one painful scar, but there were no cases of floating toes or recurrence of instability. The authors conclude that DAPPR enhances visualization and repair of plantar plates compared to plantar approaches, with favorable post-operative outcomes.
Legg-Calve-Perthes disease is a condition characterized by osteonecrosis of the femoral head typically seen in children between the ages of 4-8 years old. It results from disrupted blood supply to the femoral capital epiphysis, leading to bone death and deformity of the femoral head over time. Treatment involves relieving pain, protecting weight bearing, restoring range of motion, and minimizing femoral head deformity. Younger children with milder involvement are often treated conservatively with bracing and activity restriction while older children or those with more severe involvement may require surgical procedures like varus derotation osteotomy to improve containment of the femoral head within the acetabulum. The goals of treatment are to improve mobility
This document discusses Perthes disease, which results from loss of blood supply to the femoral head, typically affecting children ages 3-10 years old. It covers the stages of the disease from initial avascular necrosis to healing. Diagnosis involves examining radiographic changes over time as well as using imaging modalities like MRI, CT, bone scans and arthrography. Treatment aims to contain the femoral head within the acetabulum during healing to prevent deformity. Differential diagnoses and related conditions are also reviewed.
This document provides information about Achilles tendinopathy, including:
- It is a common overuse injury among athletes and the general public.
- It can be classified based on its location as insertional, non-insertional, or proximal tendinopathy.
- Risk factors include excessive loading, tight calf muscles, foot abnormalities, and medical issues.
- Diagnosis involves physical exams like the Arc sign and imaging like ultrasound or MRI.
- Treatment begins with rest, bracing, eccentric exercises, and other conservative methods, with surgery reserved for severe cases.
Congenital talipes equinovarus, or club foot, is a congenital deformity characterized by:
- Forefoot and midfoot inversion and adduction (varus)
- Heel inversion
- Ankle equinus
It is caused by congenital dysplasia of musculoskeletal structures distal to the knee. Theories for its cause include mechanical factors in utero, neuromuscular defects, hereditary factors, and arrest of fetal development. Treatment involves progressive casting or splinting to gradually correct the deformity.
- Holds foot in corrected position
Surgeon:
- Manipulates foot into corrected position
- Applies cast
Key points:
- Gentle manipulation
- Plantar flexion, abduction, derotation
- Cast applied in corrected position
- Check for pressure areas
- Weekly follow up for cast changes
Percutaneous Achilles tenotomy
- Done under local anesthesia
- Foot held in corrected position
- Small stab incision over tendon
- Tenotomy performed with small clamp or tenotomy knife
- Cast applied in corrected position
Benefits:
- Allows full correction of hindfoot equinus
- Minimally invasive
- Low complication rate
Risks
Clubfoot, or congenital talipes equino varus (CTEV), is a birth defect where the foot is twisted inward and downward. It has 4 main deformities - adduction of the forefoot, inversion/varus of the hindfoot, equinus of the hindfoot, and cavus of the midfoot. Incidence is 1-2 per 1000 births and is more common in males. Etiology may include chromosomal, embryonic, neurological, and fetal theories. Pathoanatomy involves twisting of the talus, calcaneus, and other bones. Treatment goals are to realign the bones through serial casting or surgery. The Ponseti method uses serial plaster casts and foot manipulation to gradually
Fibular deficiency, or fibular hemimelia, is a rare congenital disorder where there is partial or complete absence of the fibula bone. It can cause a range of abnormalities in the leg including limb length discrepancy, foot and ankle deformities, and knee deformities. Treatment depends on the severity of deformities and expected limb length discrepancy. For severe cases with over 25cm expected discrepancy or non-functional foot, amputation is recommended. Mild cases with functional foot may be treated with foot reconstruction and limb lengthening procedures. The goals are to manage limb length, correct bone angles, and achieve a plantigrade, painless foot.
This document discusses obstetric brachial plexus palsy (OBPP), including its causes, presentation, evaluation, treatment, and long-term management. It notes that OBPP is caused by stretching or avulsion of the brachial plexus nerves during childbirth. Clinical assessment focuses on determining the specific roots involved and severity of injury. Management involves initial physiotherapy followed by surgical repair or reconstruction if needed to address nerve injuries or resulting musculoskeletal deformities. The goal is to restore function and prevent long-term complications through a multidisciplinary approach.
Operative treatment of osteoporotic spinal fracturesAlexander Bardis
Osteoporosis can lead to spinal fractures that are traditionally treated with bed rest, braces, and pain medications. However, this risks further bone loss and weakness. The document discusses operative treatments for osteoporotic spinal fractures including spinal fixation and minimally invasive techniques like vertebroplasty and kyphoplasty. It outlines challenges posed by osteoporosis like early and late hardware failure. Methods to improve screw fixation in weak bone are described, such as cement augmentation, screw design modifications, and technique adjustments. Vertebroplasty and kyphoplasty provide pain relief but kyphoplasty can restore lost height while vertebroplasty risks cement leakage. Operative fixation and minimally invasive treatments can successfully
This document summarizes congenital talipes equino varus, or club foot, which occurs in approximately 1-2 per 1000 live births. Club foot is characterized by an inverted heel, hindfoot varus, and forefoot adduction and supination. It is caused by unknown factors that may include genetic defects or abnormal positioning in the womb. Treatment involves manipulation, casting, and sometimes surgery to correct contractures and produce a plantigrade foot.
Osteoporosis surgical Spine tips and tricks Ghazwan Bayaty
This document discusses osteoporosis, including its definition, prevalence, risk factors, clinical presentation, diagnosis, and treatment options. Some key points:
- Osteoporosis is a systemic skeletal disorder characterized by low bone mass and deterioration of bone tissue, leading to increased fracture risk. It is most prevalent in postmenopausal women and the elderly.
- Risk factors include older age, female sex, family history, smoking, low calcium intake, and medications like steroids. Common fractures are of the spine, hip, and wrist.
- Diagnosis involves assessing risk factors, physical exam for signs like height loss, and bone mineral density testing via DEXA scan. Treatment focuses on lifestyle
Proximal femoral focal deficiency (PFFD) is a birth defect where the femur is shorter than normal with discontinuity between the femoral neck and shaft. It can be associated with other anomalies. The cause is unknown but theories involve neural crest cell injury or chondrocyte proliferation issues. Treatment depends on the predicted femoral length at maturity and pelvic-femoral stability, with options including limb lengthening, amputation with prosthesis, and rotationplasty or arthrodesis. The goals are to address limb length inequality, joint instability, and functional deficits.
Legg Calve Perthes Disease (LCPD) is osteonecrosis of the femoral head that typically affects children between the ages of 4-10. For patients under 6 years old with minimal involvement, the prognosis is generally good and treatment involves rest and anti-inflammatories. For patients between 6-8 years old with more involvement, containment of the femoral head through bracing or surgery is often recommended. Patients presenting after age 9 usually have a poor prognosis due to more advanced involvement and are treated with early containment procedures, though stiffness can be a complication.
The document discusses Legg-Calvé-Perthes disease, which is avascular necrosis of the femoral head that typically affects children between the ages of 3-12. It causes the loss of blood supply to the capital femoral epiphysis. The document covers the background, etiology, pathology, presentation, investigations, classifications, treatment options and long term outcomes of Legg-Calvé-Perthes disease.
Imaging findings of metabolic bone diseases Pankaj Kaira
This document discusses various metabolic bone diseases including osteoporosis, rickets, osteomalacia, and others. It provides details on:
- The definition and causes of osteoporosis as well as how it leads to loss of horizontal trabecular bone.
- The differences between rickets, which affects growth plates, and osteomalacia, which affects mineralization of bone. Causes include vitamin D deficiency and other disorders.
- Features of various other metabolic bone diseases like hypophosphatasia, hyperparathyroidism, and their effects on bone structure and mineralization.
This document discusses equinus, a condition where the ankle cannot fully dorsiflex. It may present as a consequence of other foot deformities like Charcot arthropathy or plantar fasciitis. The history of equinus treatment is reviewed, beginning with references from ancient Greece and the first documented surgical correction. Anatomy of the gastrocnemius and soleus muscles is described. Equinus is classified into muscular, osseous, pseudoequinus, and combination types. Compensations elsewhere in the leg due to equinus are listed from the lumbar spine to the forefoot. Tests to evaluate equinus include the Silfverskiold test and stress radiographs. Conservative treatments like stretching and heel lifts are outlined
The document discusses the anatomy, etiology, pathoanatomy, clinical presentation, diagnosis, and treatment of congenital vertical talus (CVT). CVT is a rigid flatfoot deformity where the talus is vertically oriented. Treatment involves serial casting to stretch soft tissues, with the goal of restoring normal anatomy. However, most cases require major reconstructive surgery like single-stage releases to reduce the talonavicular joint and correct contractures. Post-surgery, the anterior tibial tendon may be transferred to help stabilize and support the correction. Serial casting alone rarely achieves full correction of CVT.
Blount's disease is a developmental condition characterized by a disturbance of orderly bone growth in the upper tibia. This results in a varus deformity of the knee. It is more common in obese children who start walking early and has been linked to hereditary factors. Radiographs show a widened growth plate medially with beaking of the metaphysis. Treatment depends on age and severity but may include bracing, corrective osteotomies, or hemiepiphysiodesis in more severe cases. Complications can include recurrence of deformity or nerve palsies. Proper treatment can prevent long term osteoarthritis.
Osteotomy around the knee in children.when and why?ROBERT ELBAUM
Osteotomy around the knee in children is sometimes needed to correct complex knee deformities that cannot be addressed through epiphysiodesis alone. Indications for osteotomy include constitutional angular deformities, secondary deformities from conditions like rickets or trauma, and rotational malalignments affecting the patella. While osteotomy can restore knee anatomy, the procedure carries risks of complications in over 60% of cases, including loss of correction, fractures, infections and vascular issues. Careful pre-operative planning is needed to determine if osteotomy is truly required and to minimize potential complications.
Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex deformity of the foot characterized by four components - talus in plantar flexion (equinus), subtalar joint in medial rotation and inversion, and forefoot adduction. It has multifactorial etiology with both genetic and environmental factors playing a role. Treatment involves serial casting of the foot based on Ponseti's method to gradually correct the deformity, which may be augmented with a small percutaneous tenotomy of the Achilles tendon if needed. Proper bracing is then used to maintain the correction achieved. Imaging such as X-rays and MRI can help evaluate the severity of deformity and
Perthes disease is a childhood condition that affects the hip. It results from a temporary loss of blood supply to the femoral head. The key points are:
- It typically affects children between the ages of 4-10 years old and is more common in boys.
- The exact cause is unknown but theories involve vascular compromise to the femoral head.
- Presentation includes limping, groin or thigh pain that increases with activity. Imaging shows changes to the femoral head over different stages.
- Treatment depends on the stage and age of the child, ranging from non-operative bracing and casting to surgical procedures like osteotomies if containment is needed to prevent further deformity and damage.
Perthes disease is a childhood condition that affects the blood supply to the femoral head, causing bone death (avascular necrosis). It most commonly affects boys between ages 4-8. While the disease process is self-limiting, it can have permanent effects on the femoral head shape and hip function. Treatment aims to contain the femoral head within the acetabulum during healing to promote proper reshaping, through nonsurgical means like bracing or surgical options like osteotomies if needed. The long-term outcomes are evaluated using classifications like Stulberg or Mose, with the goal of achieving a spherical femoral head congruent with the acetabulum. Management approaches vary between centers based on each child's severity and prognosis
This document discusses sacroiliac joint dysfunction. It covers anatomy of the sacrum, sacral motions including nutation and counter nutation, and types of sacral somatic dysfunction. Diagnosis involves history, physical exam including special tests like Faber, Gillett and Yeoman's tests, and sacroiliac joint injections which are the gold standard. Management can include soft tissue techniques, muscle energy techniques, counterstrain and other osteopathic manipulative medicine.
Congenital talipes equinovarus, or club foot, is a congenital deformity characterized by:
- Forefoot and midfoot inversion and adduction (varus)
- Heel inversion
- Ankle equinus
It is caused by congenital dysplasia of musculoskeletal structures distal to the knee. Theories for its cause include mechanical factors in utero, neuromuscular defects, hereditary factors, and arrest of fetal development. Treatment involves progressive casting or splinting to gradually correct the deformity.
- Holds foot in corrected position
Surgeon:
- Manipulates foot into corrected position
- Applies cast
Key points:
- Gentle manipulation
- Plantar flexion, abduction, derotation
- Cast applied in corrected position
- Check for pressure areas
- Weekly follow up for cast changes
Percutaneous Achilles tenotomy
- Done under local anesthesia
- Foot held in corrected position
- Small stab incision over tendon
- Tenotomy performed with small clamp or tenotomy knife
- Cast applied in corrected position
Benefits:
- Allows full correction of hindfoot equinus
- Minimally invasive
- Low complication rate
Risks
Clubfoot, or congenital talipes equino varus (CTEV), is a birth defect where the foot is twisted inward and downward. It has 4 main deformities - adduction of the forefoot, inversion/varus of the hindfoot, equinus of the hindfoot, and cavus of the midfoot. Incidence is 1-2 per 1000 births and is more common in males. Etiology may include chromosomal, embryonic, neurological, and fetal theories. Pathoanatomy involves twisting of the talus, calcaneus, and other bones. Treatment goals are to realign the bones through serial casting or surgery. The Ponseti method uses serial plaster casts and foot manipulation to gradually
Fibular deficiency, or fibular hemimelia, is a rare congenital disorder where there is partial or complete absence of the fibula bone. It can cause a range of abnormalities in the leg including limb length discrepancy, foot and ankle deformities, and knee deformities. Treatment depends on the severity of deformities and expected limb length discrepancy. For severe cases with over 25cm expected discrepancy or non-functional foot, amputation is recommended. Mild cases with functional foot may be treated with foot reconstruction and limb lengthening procedures. The goals are to manage limb length, correct bone angles, and achieve a plantigrade, painless foot.
This document discusses obstetric brachial plexus palsy (OBPP), including its causes, presentation, evaluation, treatment, and long-term management. It notes that OBPP is caused by stretching or avulsion of the brachial plexus nerves during childbirth. Clinical assessment focuses on determining the specific roots involved and severity of injury. Management involves initial physiotherapy followed by surgical repair or reconstruction if needed to address nerve injuries or resulting musculoskeletal deformities. The goal is to restore function and prevent long-term complications through a multidisciplinary approach.
Operative treatment of osteoporotic spinal fracturesAlexander Bardis
Osteoporosis can lead to spinal fractures that are traditionally treated with bed rest, braces, and pain medications. However, this risks further bone loss and weakness. The document discusses operative treatments for osteoporotic spinal fractures including spinal fixation and minimally invasive techniques like vertebroplasty and kyphoplasty. It outlines challenges posed by osteoporosis like early and late hardware failure. Methods to improve screw fixation in weak bone are described, such as cement augmentation, screw design modifications, and technique adjustments. Vertebroplasty and kyphoplasty provide pain relief but kyphoplasty can restore lost height while vertebroplasty risks cement leakage. Operative fixation and minimally invasive treatments can successfully
This document summarizes congenital talipes equino varus, or club foot, which occurs in approximately 1-2 per 1000 live births. Club foot is characterized by an inverted heel, hindfoot varus, and forefoot adduction and supination. It is caused by unknown factors that may include genetic defects or abnormal positioning in the womb. Treatment involves manipulation, casting, and sometimes surgery to correct contractures and produce a plantigrade foot.
Osteoporosis surgical Spine tips and tricks Ghazwan Bayaty
This document discusses osteoporosis, including its definition, prevalence, risk factors, clinical presentation, diagnosis, and treatment options. Some key points:
- Osteoporosis is a systemic skeletal disorder characterized by low bone mass and deterioration of bone tissue, leading to increased fracture risk. It is most prevalent in postmenopausal women and the elderly.
- Risk factors include older age, female sex, family history, smoking, low calcium intake, and medications like steroids. Common fractures are of the spine, hip, and wrist.
- Diagnosis involves assessing risk factors, physical exam for signs like height loss, and bone mineral density testing via DEXA scan. Treatment focuses on lifestyle
Proximal femoral focal deficiency (PFFD) is a birth defect where the femur is shorter than normal with discontinuity between the femoral neck and shaft. It can be associated with other anomalies. The cause is unknown but theories involve neural crest cell injury or chondrocyte proliferation issues. Treatment depends on the predicted femoral length at maturity and pelvic-femoral stability, with options including limb lengthening, amputation with prosthesis, and rotationplasty or arthrodesis. The goals are to address limb length inequality, joint instability, and functional deficits.
Legg Calve Perthes Disease (LCPD) is osteonecrosis of the femoral head that typically affects children between the ages of 4-10. For patients under 6 years old with minimal involvement, the prognosis is generally good and treatment involves rest and anti-inflammatories. For patients between 6-8 years old with more involvement, containment of the femoral head through bracing or surgery is often recommended. Patients presenting after age 9 usually have a poor prognosis due to more advanced involvement and are treated with early containment procedures, though stiffness can be a complication.
The document discusses Legg-Calvé-Perthes disease, which is avascular necrosis of the femoral head that typically affects children between the ages of 3-12. It causes the loss of blood supply to the capital femoral epiphysis. The document covers the background, etiology, pathology, presentation, investigations, classifications, treatment options and long term outcomes of Legg-Calvé-Perthes disease.
Imaging findings of metabolic bone diseases Pankaj Kaira
This document discusses various metabolic bone diseases including osteoporosis, rickets, osteomalacia, and others. It provides details on:
- The definition and causes of osteoporosis as well as how it leads to loss of horizontal trabecular bone.
- The differences between rickets, which affects growth plates, and osteomalacia, which affects mineralization of bone. Causes include vitamin D deficiency and other disorders.
- Features of various other metabolic bone diseases like hypophosphatasia, hyperparathyroidism, and their effects on bone structure and mineralization.
This document discusses equinus, a condition where the ankle cannot fully dorsiflex. It may present as a consequence of other foot deformities like Charcot arthropathy or plantar fasciitis. The history of equinus treatment is reviewed, beginning with references from ancient Greece and the first documented surgical correction. Anatomy of the gastrocnemius and soleus muscles is described. Equinus is classified into muscular, osseous, pseudoequinus, and combination types. Compensations elsewhere in the leg due to equinus are listed from the lumbar spine to the forefoot. Tests to evaluate equinus include the Silfverskiold test and stress radiographs. Conservative treatments like stretching and heel lifts are outlined
The document discusses the anatomy, etiology, pathoanatomy, clinical presentation, diagnosis, and treatment of congenital vertical talus (CVT). CVT is a rigid flatfoot deformity where the talus is vertically oriented. Treatment involves serial casting to stretch soft tissues, with the goal of restoring normal anatomy. However, most cases require major reconstructive surgery like single-stage releases to reduce the talonavicular joint and correct contractures. Post-surgery, the anterior tibial tendon may be transferred to help stabilize and support the correction. Serial casting alone rarely achieves full correction of CVT.
Blount's disease is a developmental condition characterized by a disturbance of orderly bone growth in the upper tibia. This results in a varus deformity of the knee. It is more common in obese children who start walking early and has been linked to hereditary factors. Radiographs show a widened growth plate medially with beaking of the metaphysis. Treatment depends on age and severity but may include bracing, corrective osteotomies, or hemiepiphysiodesis in more severe cases. Complications can include recurrence of deformity or nerve palsies. Proper treatment can prevent long term osteoarthritis.
Osteotomy around the knee in children.when and why?ROBERT ELBAUM
Osteotomy around the knee in children is sometimes needed to correct complex knee deformities that cannot be addressed through epiphysiodesis alone. Indications for osteotomy include constitutional angular deformities, secondary deformities from conditions like rickets or trauma, and rotational malalignments affecting the patella. While osteotomy can restore knee anatomy, the procedure carries risks of complications in over 60% of cases, including loss of correction, fractures, infections and vascular issues. Careful pre-operative planning is needed to determine if osteotomy is truly required and to minimize potential complications.
Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex deformity of the foot characterized by four components - talus in plantar flexion (equinus), subtalar joint in medial rotation and inversion, and forefoot adduction. It has multifactorial etiology with both genetic and environmental factors playing a role. Treatment involves serial casting of the foot based on Ponseti's method to gradually correct the deformity, which may be augmented with a small percutaneous tenotomy of the Achilles tendon if needed. Proper bracing is then used to maintain the correction achieved. Imaging such as X-rays and MRI can help evaluate the severity of deformity and
Perthes disease is a childhood condition that affects the hip. It results from a temporary loss of blood supply to the femoral head. The key points are:
- It typically affects children between the ages of 4-10 years old and is more common in boys.
- The exact cause is unknown but theories involve vascular compromise to the femoral head.
- Presentation includes limping, groin or thigh pain that increases with activity. Imaging shows changes to the femoral head over different stages.
- Treatment depends on the stage and age of the child, ranging from non-operative bracing and casting to surgical procedures like osteotomies if containment is needed to prevent further deformity and damage.
Perthes disease is a childhood condition that affects the blood supply to the femoral head, causing bone death (avascular necrosis). It most commonly affects boys between ages 4-8. While the disease process is self-limiting, it can have permanent effects on the femoral head shape and hip function. Treatment aims to contain the femoral head within the acetabulum during healing to promote proper reshaping, through nonsurgical means like bracing or surgical options like osteotomies if needed. The long-term outcomes are evaluated using classifications like Stulberg or Mose, with the goal of achieving a spherical femoral head congruent with the acetabulum. Management approaches vary between centers based on each child's severity and prognosis
This document discusses sacroiliac joint dysfunction. It covers anatomy of the sacrum, sacral motions including nutation and counter nutation, and types of sacral somatic dysfunction. Diagnosis involves history, physical exam including special tests like Faber, Gillett and Yeoman's tests, and sacroiliac joint injections which are the gold standard. Management can include soft tissue techniques, muscle energy techniques, counterstrain and other osteopathic manipulative medicine.
This document provides an overview of scoliosis, including definitions, classifications, anatomy, clinical features, evaluation, and x-ray views. Scoliosis is defined as a lateral curvature of the spine with rotation greater than 10 degrees. It can be classified into structural (idiopathic, congenital, neuromuscular) and non-structural types. Evaluation of a patient with scoliosis involves history, physical exam including Adams forward bending test, and x-rays of the spine.
This document provides a literature review on differential diagnosis of hip pain. It begins with an overview of hip structure and function. Common causes of hip pain are then discussed, including arthritis, traumatic injuries, vascular disorders, developmental issues, and other soft tissue injuries around the hip joint. For each condition, the document describes definitions, causes, clinical features, diagnosis methods where relevant. Case studies on osteoarthritis, rheumatoid arthritis, and developmental dysplasia of the hip are also summarized. The review provides a comprehensive guide to differential diagnosis of hip pain covering multiple pathologies.
The document discusses the biomechanics of the spine. It describes the structure of the spine including the 33 vertebrae and intervertebral disks. It discusses the articulations between vertebrae including the intervertebral joints between vertebral bodies and disks, and the zygapophyseal joints between articular processes. It also describes the ligaments that connect vertebrae like the anterior and posterior longitudinal ligaments. The spine functions to provide support, stability, and mobility and withstands various forces like axial compression, tension, bending, torsion and shear stresses.
- Ankylosing spondylitis is an inflammatory disorder that primarily affects the axial skeleton including the spine and sacroiliac joints. It has a strong association with the HLA-B27 gene.
- The disease usually begins in young adults and presents as inflammatory back pain. Diagnosis requires radiographic evidence of sacroiliitis along with symptoms of back pain and stiffness.
- While the exact cause is unknown, it is thought to be immune-mediated potentially triggered by intestinal bacteria in genetically susceptible individuals with HLA-B27. Tumor necrosis factor inhibitors can provide relief of symptoms.
Developmental dysplasia of the hip (DDH) is a spectrum of abnormalities including hip dysplasia, subluxation, and dislocation caused by capsular laxity and mechanical factors during development. DDH is most common in females and the left hip. Risk factors include being firstborn, breech position, and family history. Presentation depends on age, ranging from asymptomatic in newborns to Trendelenburg gait in older children. Treatment options include non-operative methods like Pavlik harness for infants or closed reduction and spica casting for older infants, and operative methods like open reduction and osteotomies for older children with residual dysplasia.
Scoliosis presentation of indian standards.pptdev071100
Scoliosis is defined as an abnormal lateral curvature of the spine. It was first described by Hippocrates in ancient Greece. Various important developments in scoliosis treatment followed, including the first surgery by Guerin in 1839 and the first use of x-rays by Roentgen in 1895. Scoliosis is classified as either non-structural or structural. Non-structural scoliosis is more mild and non-progressive, while structural scoliosis involves vertebral rotation and is more likely to progress. School screenings using methods like the Adam's forward bend test and scoliometer are important for early detection of scoliosis. Radiographic assessment including measuring the Risser sign is also used to evaluate
scoliosis management and defination with treatmentJay Tewari
Scoliosis is an abnormal lateral curvature of the spine. It was first described by Hippocrates and its name comes from the Greek word meaning "twisted". While some curves are non-structural and non-progressive, structural curves are more likely to progress over time as they involve rotation of the vertebrae. School screenings using the Adam's forward bend test and scoliometer are effective for early detection. Radiographs are important for diagnosis, measuring curve magnitude, and determining skeletal maturity using the Risser sign or Greulich and Pyle atlas. Early detection and treatment can help reduce the number of severe cases requiring surgery.
Ankylosing spondylitis clinical feature and diagnosisdattasrisaila
Ankylosing spondylitis is an inflammatory arthritis that primarily affects the spine and sacroiliac joints. It presents with inflammatory back pain and stiffness that improves with exercise. Diagnosis requires radiographic evidence of sacroiliitis along with limitations in spinal mobility. The disease progresses over time, leading to fusion of the vertebrae and loss of spinal movement. It is strongly associated with the HLA-B27 gene.
This document provides an overview of spasticity, including:
- Definitions and descriptions of spasticity and the underlying pathophysiology.
- Common causes of spasticity like cerebral palsy, stroke, multiple sclerosis, and spinal cord injury.
- Methods for assessing spasticity severity, including the Ashworth scale and pendulum tests.
- Goals and approaches for managing spasticity, which may involve eliminating triggers, non-pharmacological interventions, medications, and occasionally surgery.
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2. “Dogs are born with normal hips”
1
Alexander, J.W. (1992) The Veterinary Clinics of North America. Vol 22, Number 3
3. “Embryonically, the hip is laid down
as a single unit from mesenchymal tissue,
and it develops normally as long as the
components are left in full contact”
2
Strayer LM (1943) “The embriology of the human hip joint” Yale J Biol Med 16: 13-26
7. 6
• 87 dogs from birth to 30 days of age were
dissected.
• In 3 of these dogs (all were 30 days old)
he found an oedematous femoral head
ligament with a few torn fibers with dots of
haemorrhage at the point of the tears.
Riser, W (1975) The Dysplastic Hip Joint: Radiologic and
Histologic Development Vet Pathol 1975 12: 279
8. 7
• In dogs that were 30 to 60 days of age
the first signs detected by radiography
were femoral head subluxation and a
retardation in the development of the
craniodorsal acetabular rim.
Riser, W (1975) The Dysplastic Hip Joint: Radiologic and
Histologic Development Vet Pathol 1975 12: 279
10. 9
• Lust et al used a lineage of Labrador Retrievers
with high risk for dysplasia (90% dysplastic
offspring) to study the early stage of the disease.
• Most joints studied were from 3 to 6 month old
dogs.
• He found a proliferative synovitis (from mild
to severe) in all joints studied from the high
risk group. In the control group (Labrador
Retrievers) 50% of the joints had synovitis, all
in the mildest form.
Lust, G; Summers, B. (1981) Early, asymptomatic stage of
degenerative joint disease in canine hip joints.
Am J Vet Research, vol 42, nr 11, pg 1849-1855.
11. 10
“This study provides evidence that
synovial fluid and round ligament volume
increase early in the course of osteoarthritis
in dogs with incipient hip dysplasia.”
“Microscopically, studies of the synovial
membranes support the view that these
changes result from inflammation.”
Lust, G; Summers, B. (1981) Early, asymptomatic stage of
degenerative joint disease in canine hip joints.
Am J Vet Research, vol 42, nr 11, pg 1849-1855.
12. Synovitis
Cartilage
damage
Radiographic
signs of disease
11
The data points to a time sequence of events:
It is therefore very likely that ALL of our patients
at the time of radiographic diagnosis have some
level of cartilage damage.
Lust, G; Summers, B. (1981) Early, asymptomatic stage of
degenerative joint disease in canine hip joints.
Am J Vet Research, vol 42, nr 11, pg 1849-1855.
13. 12
At arthroscopy 96% of the joints
had some form of cartilage lesion
50% of the joints had either deep fissuring
or full thickness cartilage loss
81% had partial tearing of the femoral head
ligament and 7% a complete rupture
93% of the joints had lesions of the labrum
(tearing in 44% and avulsion in 49%)
Holsworth, IG, et al (2005) Comparison of arthroscopic and
radiographic abnormalities in the hip joints of juvenile dogs
with hip dysplasia JAVMA, vol 227, nr 7: 1091-1094
The authors studied 52 dogs (age 5½ to 15½ months old);
Total number of hips = 70
Radiographically, 43% of the joints had NO signs of DJD
and 33% considered to have mild signs
14. 13
Hip Fluid Seal
during distractive forces
helps to generate negative
intra-articular pressure
resulting in a stabilizing force
– Hip Fluid Seal or Suction Seal –
The acetabular labrum constrains the fluid in the joint,
sealing it from fluid extravasion.
during loading
action over intra-articular
fluid pressure
15. 14
Ferguson et al. (2003) An in vitro investigation of the
acetabular labral seal in hip joint mechanics.
Journal of Biomechanics 36 (2003) 171–178
Hydrostatic fluid pressurisation
within the intra-articular space
is greater with the labrum than
without it.
Cartilage consolidation is
quicker without the Labrum
The Labrum adds an extra resistance to the flow path
for interstitial fluid expression
16. 15
• Resistance to rotation, which reflects
articular cartilage friction, was significantly
increased following focal labrectomy at 1-3
times Body Weight loading, and following
complete labrectomy at all load levels.
• The acetabular labrum appears to maintain
a low friction environment, possibly by
sealing the joint from fluid exudation.
Yongnam Song et al (2012) Articular cartilage friction increases in
hip joints after the removal of acetabular labrum.
Journal of Biomechanics 45 (2012) 524–530
17. 16
Nepple et al (2014) The hip fluid seal - Part II: The effect of an acetabular
labral tear, repair, resection, and reconstruction on hip stability to
distraction. Knee Surg Sports Traumatol Arthrosc (2014) 22: 730–736
18. 17
• Surgically executed unilateral eversion of the
labrum in 20 Mongrel puppies, 6 week old.
• He observed dysplastic characteristics
(subluxation, shallow acetabuli) and gross
cartilage abnormalities in all operated joints.
• In his words: “despite the tight closure of the
joint capsule after eversion of the acetabular
labrum, acetabular dysplasia with subluxation
of the femoral head gradually developed
following surgery”.
Young-Hoo Kim (1984) Acetabular dysplasia and osteoarthritis
developed by an eversion of the acetabular labrum.
Yonsei Medical Journal vol 25, nr 2, 1984
19. 18
Coxofemoral joints in
which subluxation
was demonstrated
radiographically had
greater synovial fluid
and round ligament
volumes compared
with non-subluxated,
normal joints.
• Low prevalence line of dogs:
usually free of dysplasia at 9 months of age
• High-dysplastic line: 90% dysplastic at 9 months of age
Lust, G et al (1980) A Relationship between degree of laxity and
synovial fluid volume in coxofemoral joints of dogs predisposed
for hip dysplasia. Am J Vet Research, vol 41, nr 1, pg 55-60
20. 19
Lust, G et al (1980) A Relationship between degree of laxity and
synovial fluid volume in coxofemoral joints of dogs predisposed
for hip dysplasia. Am J Vet Research, vol 41, nr 1, pg 55-60
Subluxation was observed only in the presence of greater
than normal synovial fluid and round ligament volumes.
These data indicate that increased synovial fluid volume is one
biomechanical component of abnormal laxity and subluxation.
21. 20
Riser (1975) Surgically Induced Hip Dysplasia
Vet Pathol 12 : 306-315 (1975)
• In 5 dogs the tendons of the obturators
(int and ext) and the gemelli were surgically
severed at 4 months of age.
• All operated hips became severely dysplastic.
Muscular component destruction
also creates dysplasia
22. There are several mechanisms acting
together and contributing to stability
… …
labrum
fluid seal
capsule
muscle / tendon
units
neurological
networks
21
23. 22
Pountney, T; et al (2006) Hip dislocation in cerebral palsy.
BMJ vol 332, 1 APRIL 2006
• In children with cerebral palsy the hip is
normal at birth but the effects of delayed
motor development lead to dysplasia.
Asymmetrical activity of the muscles
surrounding the hip and lack of load bearing
affect bone development and are the main
causes of subluxation and dislocation.
• Lateral migration of the hip (subluxation or
partial dislocation) occurs in 30-60% of
children with cerebral palsy who are not
walking independently at 5 years.
24. • 92 young dogs (less than 12 months old), hip dysplasia prone on
the basis of genealogical records were studied at necropsy
• observed DJD of the Hip in 71%; of the Stifle in 22%
and of the Shoulder in 38%
• 40% had Multiple Joints Involved (excludes dogs with only same
joint bilaterally affected)
• and the ELBOW was not studied
• “Possibly, there is a systemic basis for joint degeneration with
variable expression in different joints”
• This can link hip dysplasia to the other disease that are caused
by abnormal progression of endochondral ossification (Shoulder
OCD, Elbow Dysplasia, etc ...)
Olsewski, J M; Lust, G; et al (1983) Degenerative Joint Disease:
Multiple Joint Involvement in Young and Mature Dogs.
Am J Vet Research, 1983, vol 44, nr 7
23
25. Birgit Lieser (2003); Morphological and biomechanical properties of the hip joint
in the Dog (Canis familiaris); Dissertation for the veterinary doctorate - Veterinary
Faculty of the Ludwig Maximilian University of Munich
24
BODY WEIGHT
25% 50% 75% 100%
150% 200% 250% 300%
400%
26. 25
Birgit Lieser (2003); Morphological and biomechanical properties of the hip joint
in the Dog (Canis familiaris); Dissertation for the veterinary doctorate - Veterinary
Faculty of the Ludwig Maximilian University of Munich
• At low loads and physiological angulation contact areas were
mainly found at the peripheral margin of the cranial and
caudal part of the facies lunata and caput ossis femoris
• At the cranial roof of the acetabulum a joint space was evident
in the loaded specimens up to 75% body weight.
Under increasing loads the contact areas expanded towards
the joint centre.
• The results of this study established proof of the
inhomogeneous load distribution in the canine hip joint.
For the first time it was shown that the canine hip joint is not
congruous as commonly assumed but maintains a
physiological incongruence.
This guarantees for an optimal load distribution in the joint and
for a better nutrition of the joint cartilage
27. 26
The physiological
incongruence
may contribute to
optimal load
distribution
specially on
higher load values
Birgit Lieser (2003); Morphological and biomechanical properties of the hip joint
in the Dog (Canis familiaris); Dissertation for the veterinary doctorate - Veterinary
Faculty of the Ludwig Maximilian University of Munich
28. 27
• Micro-fractures of the
acetabular rim (Riser)
• Capsule stretching
and tearing
• Inflammation
In the young dog
pain has been attributed to:
• Degenerative joint
disease and its
consequences in
cartilage and
subchondral bone
In the older dog
pain has been attributed to:
29. 28
C.H. Huang, et al. (2013) The Innervation of Canine Hip Joint Capsule:
An Anatomic Study Anat. Histol. Embryol. 42 (2013) 425-431
• The canine hip joint capsule receives
multiple innervations from articular
branches of 4 nerves.
They are articular nerve fibres of femoral,
obturator, cranial gluteal and sciatic
nerves from the cranioventral, caudoventral,
craniolateral and dorsolateral directions of
the joint, respectively
30. 29
C.H. Huang, et al. (2013) The Innervation of Canine Hip Joint Capsule:
An Anatomic Study Anat. Histol. Embryol. 42 (2013) 425-431
31. • Does it have an effect on full thickness
cartilage loss and nociception by the
subchondral bone? NO
• Does it have an effect on the total
innervation of the hip capsule? NO
• Is re-inervation a possibility? YES
30
Hip denervation has been proposed
as a palliative measure for hip dysplasia
These questions and others we must ask
of the DARTHROPLASTY
32. In my opinion there is a class of hip dysplasia affected dogs
that should be called compensated cases on a clinical basis.
31
Conservative treatment